ES2213260T3 - ULTRASONIC CLAMP COAGULATION INSTRUMENT WITH IMPROVED MOUNTED CLAMP ARM. - Google Patents

Abstract

A COAGULATOR ULTRASONIC SURGICAL DEVICE IS CONFIGURED BY TAPE TO MAKE THE CUTTING, COAGULATION AND FASTENING OF FABRIC DURING SURGICAL OPERATIONS. THE APPLIANCE INCLUDES AN EXTENSIVE PORTION THAT HAS AN ARTICULATED CLAMP ARM AT A DISTAL END OF THE SAME TO HOLD THE FABRIC AGAINST AN ASSOCIATED ULTRASONIC FINAL EFFECTOR. AN ASSEMBLY OF THE CLAMP ARM OF THE APPLIANCE IS CONTACTED BY INTERFERENCE WITH THE ARTICULATED ARM OF THE CLAMP, KEEPING THE CLAMP ARM IN SUBSTANTIAL ALIGNMENT WITH THE FINAL EFFECT, WHILE ADAPTING TO THE NORMAL MANUFACTURING TOLERANCES OF THE COMPONENTS.

Description

Ultrasonic clamp coagulation instrument with improved clamp arm pivotally mounted.

Technical field

The present invention relates, in general, to ultrasonic surgical devices, and more particularly, at a ultrasonic surgical clamp coagulation instrument for coagulate and / or cut tissues, which includes an arrangement to assemble pivotally a clamp arm of the instrument, which is applied by interference to the caliper arm to accommodate tolerances of manufacturing.

Background of the invention

Increasingly, surgical instruments Ultrasonic have applications in surgical procedures due to the unique performance characteristics of these instruments. Depending on the instrument settings and of the specific operational parameters, the instruments Ultrasonic surgical can provide substantially Simultaneously, tissue cutting and coagulation hemostasis, Desirably minimizing patient trauma. It is done typically the cutting action by means of an end effector in the distal end of the instrument, transmitting the effector of extreme ultrasonic energy to the tissue that comes into contact with the same. Ultrasonic instruments of this nature can be configured to be used in open surgery or in laparoscopic or endoscopic surgical procedures.

Surgical instruments have been developed ultrasonic devices that include a clamp mechanism to tighten the tissue against the end effector of the instrument to be able to Apply ultrasonic energy to the patient's tissue. It shows a provision of this type (sometimes called ultrasonic transector) in US Patent Number 5,322,055, in the that the two part form of Claim 1 is based.

Effect optimization is achieved Ultrasonic created in tissue during instrument use ultrasonic of the type indicated above by means of the efficient tissue coupling with the end effector of the instrument. This requires that the pivoting caliper arm of the instrument clamp mechanism can be placed in alignment substantial with the end effector, taking into account that the normal manufacturing tolerances of the components of the instrument can produce a small misalignment. Because the present instrument is desirably configured for its Disposable use, for a single patient, it is important that the components of the device are subject to a relatively inexpensive manufacturing, avoiding tolerances of excessively small manufacturing.

The present invention is particularly directed to an improved arrangement for mounting the pivoting caliper arm of the Present coagulation instrument by clamp. The configuration of the arrangement is desirably economical and cooperates with the arm of associated pivot clamp to position and maintain the caliper arm substantially aligned with an associated end effector, despite of the normal manufacturing tolerances of the components.

Summary of the invention

The present invention provides an instrument of ultrasonic surgical clamp comprising a housing; a outer tubular sheath that has a proximal end attached to the said housing, and a distal end; an inner member of action located reciprocally within said tubular sheath Exterior; an ultrasonic waveguide located within said outer tubular sheath and that has an end effector that extends distally with respect to said distal end of said outer tubular sheath; and a pivotally mounted caliper arm at said distal end of said outer tubular sheath for make a pivotal movement with respect to said effector of end, to hold the tissue between said clamp arm and the said end effector, the clamp arm being connected operatively with the aforementioned acting member, so that the reciprocal or reciprocal movement of said acting member pivot the aforementioned caliper arm with respect to the said end effector, including said tubular sheath outside a clamp arm mount generally located in the distal end thereof in which the cited caliper arm, characterized in that: the cited mount caliper arm has a cross section usually in inverted U shape, in which the leg portions are applied by interference to the laterally separated portions of said clamp arm, so that the aforementioned portions of legs remain forced towards each other, thus providing an action self-centering so that the caliper arm is positioned and maintained substantially aligned with said end effector; each leg portion defining a respective pivot opening; and including the pincer arm a pair of pivot pins integrals for the respective pivoting positioning in the cited pivot openings.

A surgical coagulation instrument ultrasonic incorporating the principles of the present invention is configured to allow cutting, coagulation and selective tissue retention during procedures Surgical The efficient use of the instrument is improved by set the pivoting caliper arm of the caliper mechanism of the instrument so that it stays substantially aligned with the associated ultrasonic end effector of the construction. To the recognize that normal manufacturing tolerances can produce a misalignment of the caliper arm and the effector of end, the arrangement of the caliper arm mount is applied by interference to the caliper arm, provided in this way a self-centering action that keeps the arm of clamp with the desired alignment with respect to the end effector ultrasonic. This alignment is achieved even when instrument components, including pivot clamp arm, are sized within the normal tolerances of manufacturing.

According to the Illustrated Embodiment, the Present clamp coagulation instrument includes a housing and an outer tubular sheath having a proximal end attached to the housing, preferably for rotation relative thereto. I know places or reciprocates an inner acting member with movement alternative inside the outer tubular sheath, having a operating lever mounted on the housing that performs the alternative or reciprocal reciprocal movement of the member of indoor performance

An ultrasonic waveguide is placed within the outer tubular sheath, and includes an end effector that extends distally from a distal end of the tubular sheath Exterior. To be able to couple the fabric with the end effector Ultrasonic, the instrument includes a clamp arm mounted pivotally at the distal end of the outer tubular sheath to make a movement with respect to the end effector. In this way, the tissue can be held between the clamp arm and the end effector to create the desired ultrasonic effect in the tissue. The clamp arm is operatively connected with the member of internal action, so that the alternative movement or reciprocal of the acting member pivotally move the arm of clamp with respect to the end effector.

In accordance with the present invention, the sheath outer tubular includes a clamp arm mount located generally at the distal end thereof, on which it is mounted Pivot arm pivot. So that the caliper arm is keep in the desired alignment with the end effector associated, the caliper arm mount is applied by interference to the caliper arm, desirably providing an action of self-focused on cooperation with it. Is interference application, which is accommodated by elastic forcing of the caliper arm mount, desirably accept the normal manufacturing tolerances of the components, particularly of the caliper arm, while maintaining the arm clamp substantially aligned with the end effector ultrasonic.

According to the Illustrated Embodiment, the caliper arm mount has a cross section generally U-shaped inverted. The caliper arm mount includes a pair of laterally separated leg portions that are applied by interference to the caliper arm so that the leg portions force each other. In accordance with certain Embodiments illustrated, an elongated slot extends longitudinally between the leg portions of the caliper arm mount along a portion of the inverted U-shaped band, thereby increasing the relative flexibility of leg portions.

In a preferred form, each leg portion defines a respective pivot opening to receive a pin from associated pivot for pivotal mounting of the caliper arm. In a particularly preferred, the caliper arm includes a pair of integral pivot pins, located respectively in laterally separated portions of the caliper arm. I know configure integral pivot pins for mounting respective pivot in the pivot openings defined by the leg portions of the caliper arm mount.

To facilitate the assembly of the instrument, each pivot opening is laterally open, which allows the integral pivot pins to be introduced into the pivot openings without deflection or deformation Substantially from the severely separated portions of the saddle of caliper arm or caliper arm. In an illustrated Embodiment, the elongated groove, which extends longitudinally between the pair of leg openings, is operatively attached to the pivot openings by means of a pair of pin passages, defined respectively by the leg portions, extending the pin passages from each respective pivot opening to the elongated groove that is between the leg portions.

Other features and advantages of this invention will be apparent from the following detailed description of the accompanying drawings and the Claims of the appendix.

Brief description of the drawings

Figure 1 is a perspective view of a ultrasonic surgical system that includes an instrument ultrasonic surgical coagulation;

Figure 2 in a fragmentary view in enlarged perspective of a clamp mechanism clamp coagulation instrument illustrated in Figure 1;

Figure 3 is a side elevation view, partially trimmed, of the coagulator by clamp, shown in operational association with an ultrasonic drive unit of the surgical system shown in Figure 1.

Figure 4 is an exploded view of an ultrasonic surgical clamp coagulator;

Figure 5 is a fragmentary view, enlarged of scale, of the present clamp coagulation instrument that illustrates a clamp drive mechanism thereof and a associated retention mechanism;

Figure 6 is a diagrammatic view illustrating additionally the clamp arm mechanism and the mechanism of retainer of the present clamp coagulation instrument;

Figure 7 is a diagrammatic view of the retaining mechanism;

Figure 8 is a perspective view of a clamp mechanism drive collar of the present clamp coagulation instrument;

Figure 9 is a fragmentary view in perspective of a caliper arm and the caliper arm mount associated, in accordance with the principles of this invention;

Figure 10 is a side elevational view of the caliper arm mount shown in Figure 9;

Figure 11 is a view similar to that of the Figure 9, illustrating an alternate embodiment of a frame of caliper arm in accordance with the principles of this invention;

Figure 12 is a side elevation view of the caliper arm mount shown in Figure 11;

Figure 13 is a view similar to those of the Figures 9 and 11, illustrating a further embodiment of a mount of clamp arm in accordance with the principles of this invention;

Figure 14 is a side elevational view of the caliper arm mount shown in Figure 13;

Figure 15 is a view similar to those of the Figures 9, 11, 13, showing a further embodiment of a clamp arm mount according to the principles of the present invention; Y

Figure 16 is a side elevation view of the Caliper arm mount shown in Figure 15.

Detailed description

Although the present invention is susceptible to embodiments with various shapes, is shown in the drawings and, in the This Report and an embodiment will be described below currently preferred, with the understanding that the present description should be considered as an example of the invention and not limits the invention to the specific embodiment illustrated.

The present invention relates particularly to an ultrasonic surgical clamp coagulation instrument improved, which is configured to make the cut, the coagulation and / or tissue retention during procedures Surgical The present instrument can be easily configured to be used in both surgical procedures open as in laparoscopic or endoscopic procedures. I know facilitates versatile use through selective use of ultrasonic energy When the ultrasonic components of the instrument are inactive, the tissue can be easily grasped and manipulated, as desired, without causing cuts or damage to the fabric. When the ultrasonic components are activated, the instrument allows the tissue to grip to engage with energy Ultrasonic to perform tissue coagulation, with the application of an increased pressure that efficiently effects the tissue cutting and coagulation. If desired, it can be applied ultrasonic energy to the tissue without using the clamping mechanism of the instrument through proper handling of the Ultrasonic "blade" or end effector of the device.

As will be apparent from the following description, the present clamp coagulation instrument is particularly configured for disposable use, in virtue of its direct construction. As such, it is contemplated that the instrument be used in conjunction with a drive unit Ultrasonic of a surgical system, whereby the energy Ultrasonic drive unit provides actuation desired ultrasonic of the present coagulation instrument by gripper. It will be appreciated that a clamp coagulation instrument of according to the principles of the present invention may be configured for non-disposable use, and be integrated form not separable to an ultrasonic drive unit associated. However, the separable connection is currently preferred of this clamp coagulation instrument and its unit of associated ultrasonic drive in the use of the instrument For a single patient.

Referring first to the Figures 1 and 3, there is illustrated a surgical system, designated usually as 10, which includes a coagulation instrument Ultrasonic surgical Details will be described first Preferred ultrasonic generator and drive unit Ultrasonic associated surgical system 10, and then a detailed description of the coagulation instrument will be made by ultrasonic surgical clamp, including a clamp mechanism set for graduated rotation.

The surgical system 10 includes a generator Ultrasonic 30 and an associated ultrasonic surgical instrument. The surgical instrument includes a drive unit ultrasonic, designated with the number 50, and an instrument of ultrasonic surgical coagulation 120, according to the principles of the present invention. As will be described in more detail, an ultrasonic transducer of the drive unit 50 and an ultrasonic waveguide of the clamp coagulator 120, together provide an acoustic assembly of the present system surgical, in which the acoustic assembly provides the energy Ultrasonic for surgical procedures when activated by generator 30. It should be noted that in some applications, it is called as ultrasonic drive unit 50 to a "handpiece assembly" because it is configured the surgical instrument of the surgical system so that a surgeon grab and manipulate the ultrasonic drive unit 50 during various procedures and operations. The instrument of clamp coagulation 120, in accordance with the principles of The present invention preferably includes an arrangement of scissor-type grip, which facilitates placement and instrument handling, apart from unit handling Ultrasonic drive 50.

The generator 30 of the surgical system sends a electrical signal through a cable 32 with a phase, frequency and selected deviation, determined by a control system of the generator 30. As will be described in more detail, the signal causes expand and contract one or more piezoelectric elements of the acoustic assembly of the surgical instrument, thus converting the Electric power in mechanical movement. Mechanical movement produces longitudinal waves of ultrasonic energy that propagate through the acoustic assembly in a stable acoustic wave to make the acoustic assembly vibrate with a frequency and deviation chosen. An end effector is placed at the distal end of the waveguide of the acoustic assembly in contact with the fabric of the patient to transfer the ultrasonic energy to the tissue. How I know will describe in more detail, preferably a surgical tool, such as a jaw or mechanism of clamp, to press the tissue against the end effector.

When the end effector attaches to the tissue, thermal energy or heat is generated as a result of friction, acoustic absorption and viscous losses in the tissue. Heat is enough to break the hydrogen and protein junctions, making that the highly structured protein (i.e. collagen and muscle protein) becomes denatured (that is, it becomes less organized). When proteins are denatured, a sticky clot that clogs or causes blood vessels to clot little ones. Deep coagulation of major blood vessels occurs when the effect is prolonged.

The transfer of ultrasonic energy to the tissue It produces other effects, including mechanical tearing, cutting, cavity formation, cell separation and emulsification. Both the amount of cut and the degree of coagulation obtained vary according to the deviation of the end effector, the frequency of vibration, the amount of pressure applied by the user, what sharpening of the end effector and the coupling between the effector of end and tissue.

As shown in Figure 1, generator 30 includes a control system that is integral with generator 30, a power switch 34, and a trigger mechanism 36. The power switch 34 controls the electrical power at generator 30, and when activated by means of the trigger mechanism 36, generator 30 provides power to drive the assembly acoustic of the surgical system 10 with a predetermined frequency and to operate the end effector with a predetermined level of deviation. The generator 30 drives or excites the acoustic assembly at any appropriate frequency of assembly resonance acoustic.

When generator 30 is activated by means of trigger mechanism 36, generator 30 applies electric power from continuously to a stack or assembly 40 of transducers of the acoustic assembly A phase lock loop in the system generator control 30 monitors the feedback of the acoustic assembly The phase lock loop adjusts the frequency of the electrical energy sent by the generator 30 to match with the resonant frequency of the selected longitudinal mode vibration of the acoustic assembly, including tissue loading. In addition, a second feedback loop in the system control maintains the electrical current that is supplied to the acoustic assembly at a constant preselected level to be able to achieve a substantially constant deviation in the effector of acoustic assembly end.

The electrical signal provided to the assembly acoustic causes the distal end of the waveguide, that is, the end effector, vibrate longitudinally in the range of, by example, about 20 kHz to 250 kHz, and preferably in the range from about 54 kHz to 56 kHz, and more preferably at approximately 55.5 kHz You can control the deviation of the vibrations in the end effector when controlling, for example, the amplitude of the electrical signal applied to the assembly 40 of acoustic assembly transducer by means of generator 30.

As indicated above, the mechanism Generator trigger 36 allows the user to activate the generator 30 so that electrical power can be supplied continuously to the acoustic assembly. Trigger mechanism 36 preferably comprises a foot activation switch that is removably coupled or connected to generator 30 by middle of a cable or conductor. Alternatively, it can be configured the trigger mechanism as a hand switch incorporated in the ultrasonic drive unit 50, to allow the Generator 30 is activated by the user.

The generator 30 also has a line of energy 38 to be inserted into a unit electro-surgical or in an electrical connection conventional. It is contemplated that generator 30 may also be activated by a direct current (DC) source, such as, by Example, a battery. The generator 30 may include any appropriate generator, such as model number GENO1, available in Ethicon Endo-Surgery, Inc.

Referring to Figures 1 and 3, the ultrasonic drive unit 50 of the surgical instrument includes 52 multi-piece housing, adapted to insulate to the operator of the vibrations of the acoustic assembly. The housing 52 of the drive unit may be formed to be held by a user in a conventional manner, but it considers that the present clamp coagulator 120 is mainly will grab and be handled in a scissor type arrangement, provided by an instrument housing, as will describe. Although multi-piece housing 52 is illustrated, housing 52 may comprise a single component or unitary.

The housing 52 of the drive unit Ultrasonic 50 generally includes a proximal end, an end distal and a cavity that extends longitudinally therein. The distal end of the housing 52 includes an opening 60, configured to allow the acoustic assembly of the system surgical 10 extends through it, and attaches to the end near housing 52 with generator 30 via cable 32. Cable 32 preferably includes conduits or vents 62 to allow air to enter the housing 52 of the ultrasonic drive unit 50 to cool the assembly of transducers 40 of the acoustic assembly.

Housing 52 of the unit is built ultrasonic drive 50 preferably of a plastic durable, such as Ultem®. It is also contemplated that the accommodation 52 can alternatively be made from a variety of materials which include other plastics (i.e. a crystal polymer liquid (LCP), nylon or polycarbonate). A drive unit Suitable ultrasonic 50 is model number HP050, available in Ethicon Endo-Surgery, Inc.

The acoustic assembly of the surgical instrument generally includes a first acoustic portion and a second acoustic portion The ultrasonic drive unit 50 is preferably supported by the first acoustic portion, and the Clamp coagulation instrument is supported by the second acoustic portion (in the form of waveguide and end effector, as will be described). The distal end of the first portion acoustics is operatively coupled to the near end of the second acoustic portion, preferably by means of a connection threaded

As shown in Figure 3, the first acoustic portion includes the assembly or stack 40 of transducers and a mounting device 84, and the second acoustic portion includes a transmission component or functional member, named in the Present Memory as a waveguide that has an effector of extreme.

Preferably, the assembly components acoustically they are acoustically synchronized, so that the length of each component is an integer number of half waves (n λ / 2), in which the λ wave is the wave of a frequency f_ {o} of operating longitudinal vibration or preselected acoustic assembly, and n is any number integer not negative. It is also contemplated that the acoustic assembly can incorporate any appropriate arrangement of elements acoustic

Assembly 40 of assembly transducers acoustic converts generator 30 electrical signal to energy mechanical that produces a longitudinal vibratory movement of the end effector in ultrasonic frequencies. When the acoustic assembly, a fixed motion wave is generated vibratory through acoustic assembly. Deviation from vibratory movement at any point along the assembly acoustic depends on the point along the acoustic assembly in the that vibratory motion is measured. A minimum or zero crossing in the fixed wave of vibratory motion is generally called node (that is, where the movement is normally minimal), and a maximum absolute value or peak in the fixed wave is called generally anti-node. The distance between the anti-node and its closest node is a quarter of wavelength (λ / 4).

As shown in Figure 3, assembly 40 of acoustic assembly transducers, also known as "Langevin stack" generally includes a 90 portion of transduction, a first resonator 92, and a second resonator 94. The transducer assembly is preferably an integer number of half wavelengths (n λ / 2). It should be understood that the The present invention may alternatively be configured to include a transducer assembly comprising a transducer electrostatic, electromagnetic or magnetostrictive.

The distal end of the first resonator is connected 92 with the near end of the transduction section 90 and it connect the near end of the second resonator 94 with the end distal of the transduction portion 90. Preferably, it manufacture the first and second 92 and 94 resonators of titanium, aluminum, steel or any other appropriate material, and more preferably, the first steel resonator 92 is manufactured stainless 303 and the second aluminum resonator 94 is manufactured 7075-T651 The first and second resonators 92 and 94 they have a length determined by a number of variables, which includes the length of the transduction section 90, the speed of sound in the material used in resonators 92 and 94, and the fundamental frequency f_ {o} of the assembly of transducers 40. The second one can be narrowed inwards resonator 94 from its near end to function as a speed transformer and amplify vibration deviation Ultrasonic

The transduction portion 90 of the assembly of transducers 40 preferably comprises a section Piezoelectric positive electrode 96 and negative electrode 98 that alternate, in which piezoelectric elements 100 alternate between electrodes 96 and 98. The elements can be manufactured piezoelectric 100 of any appropriate material, such as example, zircanato - lead titanate, lead methaiobato, lead titanate, or other piezoelectric material. Each of the positive electrodes 96 has a hole that extends to through the center. The electrodes are electrically coupled positive and negative 96 and 98 with cables 102 and 104, respectively. Cables 102 and 104 transmit the electrical signal from the generator 30 to electrodes 96 and 98.

As illustrated in Figure 3, the 100 piezoelectric elements in compression between resonators first and second 92 and 94 by means of a bolt 106. Bolt 106 preferably has a head, a shaft and a distal end screwed. The bolt is inserted from the near end of the first resonator 92 through the holes of the first resonator 92, of electrodes 96 and 98 and piezoelectric elements 100. It thread the threaded distal end of bolt 106 into a threaded hole at the proximal end of the second resonator 94. The bolt of steel, titanium, aluminum or any other material appropriate and preferably made of titanium Ti-6A1-4V, and more preferably, of a low alloy of 4037 steel.

Piezoelectric elements 100 are excited as response to the electrical signal supplied by generator 30, to produce a fixed acoustic wave in the acoustic assembly. The electrical signal produces an electromagnetic field along the 100 piezoelectric elements, making the elements piezoelectric 100 expand and contract continuously to along the axis of the voltage gradient, producing waves Longitudinal high frequency ultrasonic energy. I know transmits the ultrasonic energy through the acoustic assembly to the end effector

The assembly assembly device 84 acoustic has a near end, a distal end and has preferably a length that is substantially equal to a integer number of half system wavelengths. The extreme next to the mounting device 84 is aligned and coupled axially with the distal end of the second resonator 94 by means of an internal threaded connection near the anti-node.  (For the purposes of this, the term "near" is defined as "exactly in" or "in close proximity a ".) It is also contemplated that the mounting device 84 can be attached to the second resonator 94 by any appropriate means, and the second resonator 94 and the mounting device can be formed 84 as a single or unitary component.

The mounting device 84 is coupled to the housing 52 of the ultrasonic drive unit 50 near a node The mounting device 84 preferably includes a integral mounting tab 108 arranged around its periphery. Preferably, mounting flange 108 is disposed in a recess ring 110, formed in the housing 52 of the unit ultrasonic drive 50, to couple the mounting device 84 to accommodation 52. A compliant member or flexible material 112, such as a pair of o-rings of silicone rubber joined by spacers, between the annular recess 110 of housing 52 and integral tab 108 of the device assembly 86, to reduce or prevent ultrasonic vibration from transmit from mounting device 84 to housing 52.

Preferably, the device is secured mounting 84 in a predetermined axial position by means of a plurality of pins 114, preferably four. The pins 114 in the longitudinal direction, separated from each other in ninety (90) degrees, around the outer periphery of the mounting device 84. The pins are attached to the housing 52 of the ultrasonic drive unit 50 and are arranged to through the grooves in the acoustic mounting flange 108 of the mounting device 84. The pins are preferably manufactured stainless steel.

Preferably, the device is configured 84 assembly to amplify the ultrasonic vibration deviation which is transmitted through the acoustic assembly to the distal end of the end effector. In a preferred embodiment, the Mounting device 84 comprises a solid, narrowed horn. To the transmit ultrasonic energy through the mounting device 84, the speed of the transmitted sound wave is amplified to through the mounting device 84. It is contemplated that the mounting device 84 be configured in any way appropriate, such as a stepped horn, a horn conical, an exponential horn, a unit gain horn, or Similary.

As shown in Figure 3, preferably the mounting device 84 is acoustically coupled to the second acoustic portion of the surgical coagulation instrument ultrasonic 120. The distal end of the device is attached assembly 84 preferably to the proximal end of the second portion acoustics by means of an internal threaded connection near a anti-node, but provisions can be used coupling alternatives.

Next, reference is made to Figure 4, illustrating an exploded view of the instrument of ultrasonic surgical coagulation 120 of the surgical system 10. Preferably, the proximal end of the coagulation instrument Ultrasonic surgical 120 receives the distal end of the unit ultrasonic drive 50, and is adapted thereto, by the insertion of the drive unit into the housing of the instrument, as shown in Figure 3. Preferably, the 120 ultrasonic surgical coagulation instrument is attached to the ultrasonic drive unit 50 and removed from it as a unit The coagulator can be discarded by clamp Ultrasonic 120 after a single use.

The surgical coagulation instrument ultrasonic 120 preferably includes a hand assembly or a housing 130 preferably comprising portions matched 131, 132 of housing, and an elongated portion or Endoscopic 150. When this instrument is configured to endoscopic use, the construction can be sized so that the portion 150 has an outside diameter of approximately 5.5 mm. The elongated portion 150 of the surgical coagulation instrument Ultrasonic 120 extends orthogonally from housing 130 of the instrument. The elongated portion can be rotated selectively 150 with respect to housing 130 as further described then. The elongated portion 150 preferably includes a tubular outer member or sheath 160, a tubular inner member of actuation 170, and the second acoustic portion of the acoustic assembly in the form of waveguide 180 which has an end effector 180 '. As will be described, the sheath is preferably joined together. exterior 160, acting member 170 and waveguide 180 to rotate graduated as a unit (together with the unit of ultrasonic drive 50) in relation to the housing 130.

As illustrated in Figure 4, preferably the near end of the waveguide is removably coupled 180 of the second acoustic portion, to mounting device 84 of the ultrasonic drive unit 50 near a anti-node, as described above. The waveguide 180 has a length that is preferably substantially equal to an integer number of half a system of wavelengths (n λ / 2). Waveguide 180 is manufactured preferably from a solid core shaft constructed of a material that efficiently propagates ultrasonic energy, such as a titanium alloy (i.e. Ti-6A1-4V) or an alloy of aluminum. It is contemplated that waveguide 180 can be manufactured alternatively of any other appropriate material.

Preferably, waveguide 180 is substantially semi-flexible. It will be recognized that the Waveguide may alternatively be substantially rigid or Can comprise a flexible cable. You can configure the guide waves to amplify the mechanical vibrations transmitted to through the waveguide to the end effector, as is known Fine in the art. Additionally, the waveguide may have of features to control the increase in vibration longitudinal along the waveguide and features for synchronize the waveguide to the resonant frequency of the system.

It will be recognized that waveguide 180 can have any appropriate cross-sectional dimension. By example, the waveguide may have a cross section substantially uniform or the waveguide can narrow in several sections or you can narrow along all your length.

As shown in Figure 4, the waveguide 180 generally has a first section 182, a second section 184 and a third section 186. The first section 182 of the guide waves extend distally from the proximal end of the guide wave, and has a cross-sectional dimension that is substantially continuous.

The first section 182 preferably includes at least one radial hole or opening 188 extending diametrically through it, being substantially perpendicular to the axis of the waveguide 180. Preferably, it places the opening 188 in a node, but it can be located in another way. It will be recognized that opening 188 can have any depth appropriate and can have any form. The opening of way that you receive a connecting pin member, which connects with each other the waveguide 180, the tubular actuating member 170 and the outer tubular sheath 160, so that they can perform a rotation joint, graduated, in relation to accommodation 130.

The second section 184 of the waveguide 180 is extends distally from the first section 182. Preferably, the second section 184 also has a cross section substantially continuous. The diameter of the second section 184 is smaller than the diameter of the first section 182 and larger than the diameter of the third section 186. When ultrasonic energy passes from the first section 182 of the waveguide 180 to the second section 184, the narrowing of the second section 184 will result at an increased amplitude of the ultrasonic energy that passes to through it.

The third section 186 extends distally from the distal end of the second section 184. The third section 186 also has a cross section that is substantially continuous. The third section 186 can also include small changes in diameter along its length. When the ultrasonic energy passes from the second section 184 of the waveguide 180 to the third section 186, the narrowing of the third section 186 will result in an increased amplitude of the Ultrasonic energy that passes through it.

The third section 186 may have a plurality of grooves or notches (not shown) formed in its circumference Exterior. The slots can be located in nodes of the guide 180 waves to act as alignment indicators for the installation of a damping sheath (not shown) and rings silicone stabilizers or flexible supports during manufacturing. Preferably, a seal is provided on the node located more distally, closer to the end effector 180 ', to reduce the passage of tissue, blood and other material in the region between the waveguide and the acting member 170.

The 180 'end effector of the waveguide 180 preferably is an integral part thereof and is formed As a single unit. Alternatively, the end effector can be connected by means of a threaded connection, or by a joint welded The distal end of the end effector is arranged near of an anti-node to synchronize the assembly acoustic at a preferred resonance frequency f_ {o} when the Acoustic assembly is not loaded with tissue. When excites the transducer assembly, the end is configured distal end effector so that it moves longitudinally in the range of, for example, approximately 10 - 500 microns from peak to peak, and preferably, in the range of about 10 to about 100 microns at a frequency default vibration f_ {o}.

According to the Illustrated Embodiment, the end effector 180 ', sometimes referred to as leaf, is preferably cylindrical to cooperate with the mechanism of associated clamp of the present clamp coagulation instrument. The end effector can receive a surface treatment appropriate, as is known in the art.

With specific reference to Figure 2, illustrates therein the clamp mechanism of the present coagulator by clamp 120, which is configured to perform an action cooperative with end effector 180 'of waveguide 180. The clamp mechanism includes a clamp arm 190 pivotally movable, which is pivotally connected, at the distal end thereof, to the distal end of the outer tubular sheath 160. It mounts a pad pad 192, preferably formed of Teflon or other appropriate low friction material, on the surface of the caliper arm to cooperate with the end effector 180 ', placing the pivoting movement of the caliper arm to the pad clamp in a parallel relationship with the end effector 180 'and in contact with it. Through this construction, the fabric to be held, it is held between pad 192 and the effector 180 'end. As illustrated, pad 192 is provided, preferably, of a saw-shaped configuration to improve tissue grip in cooperation with the effector of 180 'end.

The pivoting movement of the arm of the clamp with respect to the end effector by means of the provision of the at least one, and preferably, a pair of portions of lever 193 of the clamp arm 190 at the proximal end thereof. The lever portions are placed on the respective opposite sides of waveguide 180 and end effector 180 ', and will find in operative application with a drive portion 194 of acting member 170. In this way, the movement alternative or reciprocal of the acting member, in relation to the outer tubular sheath 160 and waveguide 180, performs the pivoting movement of the caliper arm in relation to the effector extreme The lever portions 193 can be placed, respectively, in a pair of openings defined by the portion drive 194, or properly coupled otherwise with the same, so the reciprocal or reciprocal movement of the acting member acts through the actuating portion 194 and lever portions 193 to swing the arm of gripper.

With specific reference to Figures 3, 5 and 6, the reciprocal or reciprocal movement of the member of action 170 through the provision of a collar drive, usually designated by 200, mounted on the end next to the acting member for joint rotation. For For this purpose, the drive collar includes a pair of arms 202 diametrically opposed and extending axially, having each of them a drive lug, the ones being forced actuation lugs by arms 202 until connected with the appropriate openings 206, defined by the proximal portion of the tubular actuator member 170. The rotation of the drive collar 200 together with the member of action 170 for the provision of a pair of cotters (see Figure 8) diametrically connectable to appropriate openings 210 defined by the near end of the acting member 170. A circumferential groove 211 in the actuating member 170 receives a O-ring 211 '(Figure 4) for surface connection inside of the outer sheath 160.

The rotation of the member of actuation 170 together with the outer tubular sheath 160 and the guide inner waves 180 by means of a connecting pin 212 which is extends through these instrument components. How I know illustrated in Figure 4, the tubular actuating member 170 defines an elongated groove 214, through which the pin extends connection 212 to accommodate reciprocal or reciprocal movement of the acting member in relation to the outer tubular sheath and The inner waveguide.

A rotation knob 216, mounted on the sheath outer tubular, facilitates the rotational placement of portion 150 elongated with respect to housing 130 of the instrument clamp coagulation. The connecting pin 212 joins, preferably, the knob 216 with the sheath 160, the member 170 and the 180 waveguide to rotate as a unit in relation to the housing 130. In a current embodiment, portion 216 'of hub of the rotation knob acts to mount the outer sheath 160, the acting member 170, and waveguide 180 (as a unit with the knob 216) in housing 130.

The drive collar 200 provides a portion of the clamp arm mechanism of the instrument that performs pivoting movement of the clamp arm 190 by movement alternative or reciprocal of the acting member 170. The mechanism clamp arm also includes a drive fork 220, which is operatively connected with an operating lever 222 of the instrument, in which the operating lever is located interconnected in this way with the acting member 170 of reciprocal or reciprocating movement by means of the fork drive 220 and drive collar 200. The lever Operation 222 is pivotally connected to housing 130 of the instrument (by means of a pivot assembly 223) for cooperate in the form of scissors with a hand grip portion 224 of accommodation. The movement of lever 222 towards the portion 234 hand grip soon moves the acting member 170, thus making the arm 190 of the pivot clamp towards the end effector 180 '.

An operational connection of the drive fork 220 with operating lever 222 by means of a spring 226, preferably comprising a spring compression elastic Spring 226 fits inside a slot 228 spring, defined by drive fork 220, which, in turn, it is situated between a pair of elastic eyelashes of retaining 230 of operating lever 222. Fork 220 of drive is pivotally movable with respect to the elastic tabs 230 (around the pivot assembly 223 of the housing 130) as opposed to the elastic compression spring, which rests against the surfaces of the defined spring grooves for each of the elastic eyelashes 230. In this way, the force that can be applied to acting member 170 by the pivoting movement of the operating lever 222 acting through of the drive fork 220 and the drive collar 200, is limited by the force with which the spring 226 is supported against elastic eyelashes 230. The application of a force excessive produces the pivotal displacement of the fork of drive 220 in relation to the elastic tabs 230 of the operating lever 222 as opposed to spring 226. In a Currently preferred embodiment, spring 226 is selected to limit the clamp force on the clamp arm 190 to Approximately 0.9 kg The stop portions of the housing 130 limit the displacement of operating lever 222 to avoid excessive compression of spring 226.

Rotary positioning is provided graduate of the elongated portion 150 of the present instrument 120 of clamp coagulation through the provision of a mechanism for retainer incorporated into the caliper arm mechanism of the instrument. Specifically, drive collar 200 includes a pair of separate 232 drive tabs axially with each other. A reception area of retainer between drive tabs 232, and it defines a plurality of teeth 234, circumferentially separated, which define depressions of catch reception, generally around the periphery of the drive collar 200. In one example currently preferred, twelve (12) teeth 234 are provided, thus providing the graduated positioning of the elongated portion 150 of the instrument at 30 ° intervals in relationship with the housing 130 of the instrument.

A rotational movement is additionally achieved graduated through the provision of at least one, and preferably, a pair, of diametrically opposed seals 236, provided respectively on fork arms 238 in overhang of the drive fork 220. By means of this arrangement, the fork arms 238 are located between the drive tabs 232 to apply to surfaces facing the same, and force the seals 236 to be applied to the drive collar 200. Therefore, a relative graduated rotation, in which the retainers 236 of the arms fork cooperate with drive tabs 238 to effect an reciprocal or reciprocal movement of the member of action 170. In a currently preferred example, the drive fork 220 made from polymeric material appropriate, in which the force of forcing is produced by the fork arms that act on the seals thereof, cooperating with the radial depressions defined by the collar of drive to resist the relative rotational torque of less than about 0.00368 to 0.0162 kg.m. As such, it keeps the elongated portion 150 of the coagulation instrument by clamp in any of its graduated rotary positions selected, in relation to accommodation 130, unless apply torque (for example, by means of a knob rotation 216) that exceeds this level of torque predetermined. Therefore, an action of elastic jump type graduation.

The rotation of the elongated portion 150 of the present clamp coagulation instrument 120 is performed, preferably, in conjunction with the relative rotational movement of the ultrasonic drive unit 50 with respect to the instrument housing 130. In order to join the elongated portion 150 with the ultrasonic drive unit 50 in a ratio of ultrasonic transmission, the next portion of the tubular sheath exterior 160 is preferably provided with a pair of faces of nut wrench 240 (see Figure 4). The faces of the key nuts allow the torque to be applied by a wrench appropriate torque nuts or similar to allow for this so that the waveguide 180 joins the drive unit ultrasonic 50. Therefore, the ultrasonic drive unit 50, and also the elongated portion 150 are rotary, like a unit, through proper handling of the rotation knob 216, in relation to the housing 130 of the instrument. I know dimension the interior of the housing to accommodate this type of relative rotation of drive unit 50.

Particular reference is made below to Figures 9-16, illustrating an arrangement for pivot the instrument clamp arm on the associated outer tubular sheath 160, in accordance with the present invention. As illustrated in Figures 9-16, a pivoting caliper arm with number 290, and it differs in some aspects of the clamp arm 290, described above. The clamp arm 290 includes an elongated portion 291 of clamp, in the which puts the clamp pad in contact with the tissue.

The clamp arm 290 includes a pair of 295 portions separated laterally at the proximal end of the same, each having an integral pivot pin 297 respective (one shown) in them. They join together 295 portions laterally separated from the clamp arm 290 generally in a lower drive portion thereof, designated by 293, which can be placed in operational connection with the Reciprocal acting member 170 of this instrument. In the Illustrated embodiments, a gap opening 301 of the sheath outer tubular 160 accommodates the pivoting movement of the portion of drive 293, following the alternative movement or reciprocal of the associate acting member. Therefore the arm of clamp is pivoting around a pivot axis defined by the pivot pins 297.

To create the desired ultrasonic effect in the tissue held between the clamp arm 290 and the end effector (180 ') associated, it is desirable to place the clamp arm 290 in substantial alignment with the end effector, that is, aligned so that the longitudinal axis of the end effector is found in the same plane as the longitudinal axis that extends through the caliper arm. At the same time, it is desirable that components of this instrument, including the caliper arm, be configured in a disposable way, for use with a single patient. In this way, it is desirable to avoid the need for manufacture instrument components, including arm 290 of clamp, with excessively small manufacturing tolerances or "narrow."

The present invention is particularly configured to position the clamp arm 290 in alignment substantial with the associated end effector, while accommodating Normal manufacturing tolerances of the caliper arm. This is achieved by providing the distal end of the tubular sheath exterior 160 with a caliper arm mount that is applied by interference with the clamp arm 290. In this way, the caliper arm portions are elastically forced one towards the another as a result of the application of interference with the arm of clamp, acting, therefore to self-center the clamp arm and place the caliper arm in substantial alignment with the effector extreme

Making first reference to the Embodiment of Figures 9 and 10, the caliper arm mount includes a pair of laterally separated leg portions 302, in which the caliper arm mount has a cross section Generally inverted U-shaped. Each 302 serving of leg defines a respective pivot pin opening 304. How I know you will notice, each of the pivot openings 304 is located opened laterally, and therefore, opens to an adjacent region to the caliper arm mount. This facilitates the assembly of the clamp arm 290 on the clamp arm mount without bending substantial of the clamp arm 290 or of the leg portions 302 of assembly. On the contrary, the leg portions 302 are displaced inwards towards each other, by virtue of interference application with laterally separated portions of the clamp arm, allowing, in this way, that the pins 297 pivot are located respectively in openings 304 of pivot.

Referring below to the Figures 11 and 12, a modified version of the Present clamp arm mount. As in the previous Embodiment, the clamp arm mount is provided at the distal end of the outer tubular sheath 160, and has a cross section generally inverted U-shaped, including a pair of laterally separated leg portions, each designated by 306, which generally narrow towards each other in portions lower of them. Each of these 306 leg portions defines a pivot opening 308 to receive, respectively, one of the pivot pins 297 of the clamp arm 290. Like in the Previous embodiment, each of the pivot openings 308 is It is open laterally, thus facilitating the assembly of the clamp arm by means of the arrangement of the pins 295 of pivot in the respective openings 308.

To further facilitate the assembly of the components, this Realization of the caliper arm mount includes an elongated slot 310 that extends longitudinally between the leg portions 306 along a frame of the assembly, Generally inverted U-shaped. The elongated groove improves the flexibility of the leg portions 306, thus facilitating the flexible forcing of the leg portions towards each other, while the leg portions go into interference application with the laterally separated portions of the clamp arm 290 in which the pivot pins 297 are mounted. The slot width 310 to accommodate sufficient deflection of the leg portions towards each other, to allow the provision of the pivot pins 297 in their respective openings of pivot.

The Realization of the present arm mount clamp illustrated in Figures 13 and 14 is similar to the arrangement illustrated in Figures 11 and 12, including a pair of leg portions 312 defined by the arm mount of generally inverted U-shaped clamp of the tubular sheath exterior 160. As in the previous Embodiment, a groove is defined elongated 316 by tubular sheath 160 extending between the 312 leg portions of the caliper arm mount. In this Embodiment, each of the pivot pin openings (314) (one is shown) is laterally closed, and therefore, it position the pivot pins 297 respectively with the openings 314 pivot by flexing the leg portions 312 flexibly towards the other, to achieve the desired interference application with the laterally separated portions of the clamp arm 290. I know dimension slot 216 to accommodate enough deflection towards inside the leg portions for the arrangement of the pins 297 pivot in the respective openings closed sideways.

In the Additional Embodiment shown in the Figures 15 and 16, the clamp arm mount of the member of action 116 is generally configured so that it has an inverted U-shaped cross section, including a pair of leg portions 318 separated laterally. Each of leg portions 318 defines a pivot opening 320 respective. An elongated groove 322 extends longitudinally between leg portions 318.

In this Embodiment, each of the portions defines a passage 324 of pin, which extends from the respective laterally open pivot opening, to the groove elongated 322. Therefore, the arrangement of the pin 295 pivot arm clamp 290 in opening 320 respective pivot when flexing in portions 318 of laterally separated leg while pivot pins 295 are move through the respective passer passages 324, to inside the respective pin openings 320.

To achieve the desired elastic forcing of the leg portions of the present caliper arm mount, is it is preferable that the outer tubular sheath 160 of the instrument is formed of metallic material, preferably stainless steel Surgical or similar. Efficient manufacturing can be achieved of portion 290 of caliper arm by molding by metal injection

Therefore, this is configured clamp coagulation instrument for highly versatile use and efficient, having the construction a configuration what direct and economical enough to allow its use by One patient The components of the instrument of appropriate materials for surgical applications. Under the retention mechanism, provided by cooperation of drive collar 200 and drive fork 200, the selective angular positioning of the elongated portion 150 of the instrument and the ultrasonic drive unit 50 associated, it is easily effected with respect to housing 130 of the instrument. The scissors type action provided by the pivoting operating lever 222 and by the grip portion 224 of Cooperative hand facilitates handling and positioning convenient and efficient instrument, and the operation of the clamp mechanism in the distal portion of the instrument, whereby the tissue is efficiently pushed against the end effector 180 '. The retention mechanism resists the rotation of the unit ultrasonic drive and cable assembly associated with with respect to housing 130, which is easily overcome and efficiently the resistance to rotation by the application of a sufficient torque through the knob 216 of rotation.

From the above, it will be noted that you can make numerous modifications and variations without separating from Scope of the novel concept of the present invention. Must be understand that no limitation is intended or inferred with respect to the specific Embodiment illustrated in the present the exhibition intends to cover by means of Claims of the annex, all the modifications that are are within the scope of the Claims.

Claims (7)

1. An ultrasonic surgical instrument type clamp, comprising: an accommodation (52); an outer tubular sheath (160) having a near end attached to said housing (52), and one end distal; an interior acting member (179) located with alternative movement within said tubular sheath outer (160) an ultrasonic waveguide (180) placed inside of said outer tubular sheath (160) and having a distal effector (180 ') spaced apart from said distal end of said outer tubular sheath (160); and a clamp arm (290) mounted pivotally at said distal end of said sheath outer tubular (160) to perform a pivoting movement with with respect to said end effector (180 ') to hold the fabric between said clamp arm (290) and said end effector (180 '), said arm (290) being operatively connected clamp the aforementioned acting member (170) so that a alternative movement of the aforementioned acting member (170) pivotally move said clamp arm (290) with respect to to said end effector (180 '), the said outer tubular sheath (160) including a clamp arm mount generally at the distal end thereof, on which the said clamp arm (290) is pivotally mounted, characterized in that: the aforementioned caliper arm mount has a generally inverted U-shaped cross section, in which the leg portions (306) are applied by interference to the laterally separated portions of said clamp arm (290), so that the said portions (306) of leg are forced one towards the another, thus providing a self-centered action so that the clamp arm (290) is positioned and held in substantial alignment with said end effector (180 '); each leg portion (306) defining a respective opening (308) pivot; and including the pincer arm a pair of pins (297) pivot integrals for pivoting positioning respective in the aforementioned pivot openings (308). 2. An ultrasonic surgical instrument type clamp according to claim 1, wherein each of the said openings (308) is laterally open to facilitate the pivotal assembly of said clamp arm (290). 3. A clamp-type ultrasonic instrument according to Claim 1 or Claim 2, wherein said clamp arm mount defines an elongated groove (310) extending longitudinally between said pair of portions (306) of leg. 4. An ultrasonic surgical instrument type clamp according to claim 3, wherein said groove elongated (310) extends along a frame of said U-shaped cross section inverted. 5. An ultrasonic surgical instrument type clamp according to any one of the Claims above, in which each of said portions (306) of leg defines a respective pivot opening (308), and said caliper arm (290) includes a pair of pins (297) pivot integrals located respectively in the aforementioned laterally separated portions thereof, for the respective pivoting positioning in said openings (308) of pivot 6. An ultrasonic surgical instrument type clamp according to claim 5, wherein each of the cited pivot openings (308) is laterally open for facilitate the pivotal assembly of said clamp arm (290) by the movement of said integral pivot pins (297) in the aforementioned pivot openings (308). 7. An ultrasonic surgical instrument type clamp according to claim 1, wherein said caliper arm mount defines an elongated groove (322) that is extends longitudinally between said pair of portions (306) of leg, defining each of said portions (306) of leg a passage (324) of pin extending from the respective pivot opening (308) to said elongated groove (322).